We’ve been hearing a lot about universal healthcare. But before you give up on market competition, consider that government regulation of hospitals and medical professionals makes medical care much more expensive than it need be…

One of the reasons healthcare costs are growing is that lobbyists for medical professionals and hospitals use such laws to protect their members from competition. If they keep blocking cost-saving innovations, it could backfire on them. The public will get so frustrated with the high cost of care that they will demand universal healthcare, which won’t be a picnic for the industry or the rest of us…let’s deregulate medical care so that providers can find innovative ways to deliver high-quality care cheaply.

Universal coverage sounds appealing, but it means government will be running the trains. Here and abroad, government does not have a good record when it comes to access, oversight, or innovation.

The 2008 presidential election, scheduled to be a fight over differing visions of foreign policy and domestic spending priorities, has changed significantly. The two campaigns have been focused for weeks on figuring out how much money to take from taxpayers to insulate those same taxpayers from the costs of the decisions of a variety of parties, including the Senate to which both of them belong.

But the commonality between John McCain and Barack Obama on the giant bailout is, in some ways, similar to their overstated differences in the realm of foreign policy. Real differences exist, but in football terms, this been a boring struggle back and forth between the 45-yard lines of foreign policy thought.

Although the two candidates disagree vehemently about who said what when on Iraq policy and whether to negotiate with Iran, they agree with each other on a range of issues, including humanitarian intervention, the supposed need to make Georgia and Ukraine security protectorates, and the divine mission of America to promote democracy throughout the world. In a paper posted today [.pdf], I discuss some of these similarities and differences.

One issue where there is a clear difference, at least of degree, is on the subject of Iran. McCain repeated his view during the first debate, stating flatly that “if Iran acquires nuclear weapons, it is an existential threat to the State of Israel and to other countries in the region.” McCain went on to note that “we cannot have a second Holocaust” and to describe how his “League of Democracies” [.pdf] would hold the key to unlocking the Iran problem. Not to be outdone, Obama chimed in to agree that “we cannot tolerate a nuclear Iran.”

I have argued elsewhere that the United States, with a $13 trillion economy and a defense budget the size of all other nations combined, certainly could “live with” a nuclear Iran. But since all of the candidates respond first to questions about Iran by referencing Israel, perhaps it is worth examining that country’s thoughts on the issue, since it is much smaller, weaker, and closer to Iran than the United States.

What one finds is quite interesting. It was Tzipi Livni, then foreign minister of Israel and now a candidate for PM, who noted in an interview with Haaretz last October, that she believed that Iranian nuclear weapons would not pose any “existential” threat to Israel, and that she believed that then-PM Olmert was “attempting to rally the public around him by playing on its most basic fears.”

McCain, in particular, has been at the forefront of ringing the alarm bell in the United States (and abroad) that Iran does present such an existential threat, and that the prospect of an Iranian nuclear capability would necessitate U.S. military action, and all the attendant consequences.

Question for McCain: Why are you busily promoting alarmism about what a nuclear Iran would mean to Israel? Why are you more alarmed even than those charged by Israeli citizens with protecting their well-being? Does this in any way represent responsible statesmanship?

Seven years after 9/11, we are seeing Al Qaeda’s long-term goal being realized: the destabilization and economic collapse of the United States. Even as it’s happening, the people who supported it all along want to continue facilitating our own long-term disintegration by clinging to simplistic concepts of traditional military victory and defeat. In this sense, they are possibly the most myopic, least strategic thinkers in the history of this nation.

It’s exaggeration to say that the United States is destabilized and in economic collapse, and I don’t think it’s entirely fair to say that our leaders are that simplistic. But we’re quite a bit worse off economically than we could have been had we responded strategically to terrorism rather than just reacting. And many national leaders still do need to take the strategic logic of terrorism - goading us into overreaction - to heart, and act (or refrain from acting) accordingly.

Maybe I’m wrong, but I think I’m the source for the only constitutional question asked in Thursday’s vice-presidential debate. Moderator Gwen Ifill asked one that sounded a lot like the one I asked that morning in the New York Times:

IFILL: Governor, you mentioned a moment ago the constitution might give the vice president more power than it has in the past. Do you believe as Vice President Cheney does, that the Executive Branch does not hold complete sway over the office of the vice presidency, that it it is also a member of the Legislative Branch?

PALIN: Well, our founding fathers were very wise there in allowing through the Constitution much flexibility there in the office of the vice president. And we will do what is best for the American people in tapping into that position and ushering in an agenda that is supportive and cooperative with the president’s agenda in that position. Yeah, so I do agree with him that we have a lot of flexibility in there, and we’ll do what we have to do to administer very appropriately the plans that are needed for this nation. And it is my executive experience that is partly to be attributed to my pick as V.P. with McCain, not only as a governor, but earlier on as a mayor, as an oil and gas regulator, as a business owner. It is those years of experience on an executive level that will be put to good use in the White House also.

IFILL: Vice President Cheney’s interpretation of the vice presidency?

BIDEN: Vice President Cheney has been the most dangerous vice president we’ve had probably in American history. The idea he doesn’t realize that Article I of the Constitution defines the role of the vice president of the United States, that’s the Executive Branch. He works in the Executive Branch. He should understand that. Everyone should understand that.

And the primary role of the vice president of the United States of America is to support the president of the United States of America, give that president his or her best judgment when sought, and as vice president, to preside over the Senate, only in a time when in fact there’s a tie vote. The Constitution is explicit.

The only authority the vice president has from the legislative standpoint is the vote, only when there is a tie vote. He has no authority relative to the Congress. The idea he’s part of the Legislative Branch is a bizarre notion invented by Cheney to aggrandize the power of a unitary executive and look where it has gotten us. It has been very dangerous.

Biden made more of an attempt than Palin did to answer the question Ifill asked, but his answer doesn’t make much sense. Uh, Joe, Article I covers the legislative branch. And the veep’s only power is legislative, presiding over the Senate and breaking tie votes. The Constitution doesn’t grant him any executive power.

And yet here’s Dick Cheney, co-president from at least 9/11/01 on, giving orders to shoot down planes, running large swathes of the War on Terror, and even exercising formally delegated executive powers over the control of information.

As Glenn Reynolds suggests, it’s constitutionally suspect for the president to delegate executive power to officials he can’t remove from office. He also notes that

there may be practical reasons to limit vice presidential involvement in day-to-day executive business regardless of whether we accept the characterization of the Vice Presidency as a legislative office or not. Whether or not the Vice President is seen as a legislative officer, the office of Vice President is something special. The Vice President is, after all, primarily meant to serve as a sort of spare President, and—as with spare tires or backup servers—it may be safest not to put the spare into ordinary service before it’s needed. Presidents are lost in three ways: death, resignation, and impeachment. Vice presidential involvement in policy has the potential to put the “spare” role at risk in at least two of these contexts. When Presidents resign or are impeached, it is often over matters of policy.

Although the risk that a Vice President will be involved in the precipitating events is hard to estimate, it is certainly higher for an activist Vice President than it will be for a Vice President playing a traditionally quiescent role. Though talk of impeaching the current occupants of either office is unlikely to come to anything, it illustrates the risks…. Had Carter been impeached or forced to resign as a result of the Iran debacle, Mondale’s public distance would have been important in preserving his ability to govern.

Whatever one thinks of the impeachment talk of the last few years, two and a half impeachments over our entire constitutional history is probably fewer than we ought to have had. And impeachment becomes more difficult when the president’s replacement is deeply implicated in the activities considered grounds for impeachment.

And there are other problems with a Cheney-style vice presidency as well, problems that ought to be of particular concern to unitary executive fans. One of the more convincing arguments offered by Hamilton against the idea of a plural executive is that “it tends to conceal faults, and destroy responsibility.” He continues,

The circumstances which may have led to any national miscarriage or misfortune are sometimes so complicated that, where there are a number of actors who may have had different degrees and kinds of agency, though we may clearly see upon the whole that there has been mismanagement, yet it may be impracticable to pronounce to whose account the evil which may have been incurred is truly chargeable.

That’s certainly been the case over the last seven years. As Barton Gellman has recently shown, information about the so called Terrorist Surveillance Program was so tightly held among Vice President Cheney, David Addington, and their administration allies, that President Bush was unaware until the very last moment that the top echelon of his Justice Department was ready to resign over the illegality of the original program. When an activist vice president deliberately keeps the president in the dark, it can be difficult to discern where the buck really stops.

At the constitutional convention, when Elbridge Gerry objected to the veep’s legislative role, Roger Sherman made the salient point that “If the vice-President were not to be President of the Senate, he would be without employment.” Our early vice presidents didn’t play an important role in the executive branch. Washington kept John Adams at arm’s length from policymaking, and Adams was also frustrated in his attempts to actively manage the Senate as presiding officer. The best view of the vice-president’s constitutional role is that the veep really is supposed to be a bucket of warm [fluid] unless and until he or she is called upon to assume office. And there’s good reason for that. Here’s hoping that Vice President Biden or Vice President Palin will spend less time making policy and more time attending funerals.

For those of you in the Washington, DC, area, on Sunday our local NPR station, WAMU (88.5 FM), broadcast a debate over whether the federal government should pursue a policy of universal health insurance coverage. Super-famous debaters included John Stossel of ABC News, Paul Krugman of The New York Times, and me.

The debate is now available on the NPR website, and on iTunes under “Intelligence Squared.”

Today the Supreme Court begins a new term, and so far there is little for either constitutional scholars or the general public to get excited about. While two years ago the Court split 5-4 in a full third of its cases (with Justice Kennedy in the majority on each one), and last year produced fewer such decisions (and also fewer unanimous and 8-1 verdicts) but maintained sharp divides on high-profile cases involving Guantanamo Bay, the Second Amendment, and the death penalty, the current term seems to lack any striking features. Instead we have a raft of cases involving technical issues of statutory interpretation and minor doctrinal adjustment, especially in the areas of environmental and employment law, and criminal procedure. Even the typically riveting First Amendment cases fall flat, with the FCC’s obscenity regulation turning on administrative procedure and the lone religion matter concerning a quixotic use of private speech in a public forum. We can expect to see most of these cases decided by broad majorities on narrow grounds, perhaps reflecting the “minimalist” approach Chief Justice Roberts allegedly prefers. Still, given the small number of cases – the Court filed a leisurely 67 opinions on the merits after argument last year (the lowest number since 1953) and is on pace for not many more this term – it’s hard to read any trends into the Court’s work. And the last time Court watchers protested this much about the “boring” nature of the docket, October Term 2000, we ended up with the little-known case of Bush v. Gore. We will see very soon whether next month’s election – or indeed the bailout – will make history repeat itself.